马尔尼菲篮状菌血流感染的实验室诊断

唐思诗; 李燕; 陈知行; 戴仲秋; 敖科萍; 何超

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武警医学 ›› 2020, Vol. 31 ›› Issue (12) : 1033-1037.

论著

马尔尼菲篮状菌血流感染的实验室诊断

唐思诗¹, 李燕², 陈知行¹, 戴仲秋¹, 敖科萍¹, 何超¹

作者信息 +

Laboratory diagnosis of Talaromyces marneffei associated bloodstream infections

TANG Sishi¹, LI Yan², CHEN Zhixing¹, DAI Zhongqiu¹, AO Keping¹, HE Chao¹

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文章历史 +

摘要

目的建立马尔尼菲篮状菌血流感染的实验室诊断路径,为该类疾病的诊治提供参考。方法采集疑似发生真菌血流感染的患者外周血液样本,进行血细胞计数、血涂片染色及镜检;同时进行血培养检测,将仪器报阳且涂片查见丝状真菌的样本进行温度依赖型双相生长试验,对可疑菌落采用形态学和基质辅助激光解析电离飞行时间质谱进行菌种鉴定;采用显色法检测患者血清中(1-3)-β-D葡聚糖含量;收集患者临床资料,进行统计学分析。结果纳入病例24例,平均年龄42.2岁(20~55岁),男21例,女3例,基础疾病均为艾滋病。8例(34.8%)外周血白细胞计数降低,20例(87.0%)血红蛋白下降。24例分离株经形态学及质谱鉴定为马尔尼菲篮状菌,其中1例(4.2%)外周血涂片镜检见马尔尼菲篮状菌特征形态。8例进行血清(1-3)-β-D葡聚糖检测,其中5例阳性(62.5%)。16例住院患者中,10例(62.5%)有呼吸系统感染症状,12例(75.0%)发生继发感染,住院时长平均12.0 d,住院病死率为52.3%。结论马尔尼菲篮状菌血流感染的实验室诊断应综合外周血细胞计数、血培养、真菌G试验以及临床资料,这类病例免疫力差,易继发感染,预后较差。

Abstract

Objective To establish a laboratory diagnostic pathway of talaromyces marneffei associated bloodstream infection so as to provide reference for the diagnosis and treatment of relateddiseases.Methods Peripheral blood samples were collected from the patients suspected with fungal bloodstream infection before whole blood cell count, smearing and microscopy were performed for these specimens. Blood specimens were cultured and detected with biphasic temperature culture when filamentous fungi were found in the smear of instrument alarmed-positive specimens. The suspected colonies were identified by morphology and Matrix-Assisted Laser Desorption/ Ionization Time of Flight (MALDI-TOF MS). Plasma (1,3)-β-D-glucan was determined by colorimetry. The clinical data of the patients was collected for statistical analysis.Results Twenty-four cases were included in this study, and the average age was 42.2 years old.The ratio of males to females was 7:1, and their underlying diseases were acquired immune deficiency syndrome. Among these patients, 8 (34.8%) had low white blood count and 20(87.0%) had decreased hemoglobin. All the 24 strains were identified as T. marneffei by morphology and MALDI-TOF MS. In one case (4.2%), specific morphology of T. marneffei was observed in the peripheral blood smear. Five(62.5%) of the eight patients were positive for plasma (1,3)-β-D-glucan. Among the 16 hospitalized patients, 10(62.5%)had respiratory symptoms, and 12 (75.0%) suffered secondary infections, whose median length of hospital stay was 12.0 days, and hospital mortality was 52.3%.Conclusions The laboratory diagnosis of T. marneffei associated bloodstream infections should be combined with peripheral blood cell count, blood culture, (1,3)-β-D-glucan test and clinical data.Patients who have poor immunityare more vulnerable to secondary infection and poor prognosis.

导出引用

唐思诗, 李燕, 陈知行, 戴仲秋, 敖科萍, 何超. 马尔尼菲篮状菌血流感染的实验室诊断[J]. 武警医学. 2020, 31(12): 1033-1037

TANG Sishi, LI Yan, CHEN Zhixing, DAI Zhongqiu, AO Keping, HE Chao. Laboratory diagnosis of Talaromyces marneffei associated bloodstream infections[J]. Medical Journal of the Chinese People Armed Police Forces. 2020, 31(12): 1033-1037

中图分类号： R446.5

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